1. WHO concept of essential
medicines
Dr. Gyanendra Raj Joshi
PharmD, RPh

2. Rational behind Essential Medicine
List
• Indiscriminate marketing of drugs without
considering the health needs
• Access of people living in rural areas to drugs
• For poor and disadvantaged medicines are :
– Unavailable
– Unaffordable
– Unsafe
– Improperly used

3. • The concept of essential medicines
A limited range of carefully selected essential
medicines leads to better health care, better
drug management, and lower costs.
• Definition of essential medicines
Essential medicines are those that satisfy the
priority health care needs of the population.

4. • Essential medicines are intended to be
available within the context of functioning
health systems
– at all times
– in adequate amounts,
– in the appropriate dosage forms,
– with assured quality and adequate information
and
– at a price the individual and the community can
afford.

5. Advantages
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Limited range
High Quality care
Better management of medicines
More cost effective use of resources
Real health gains
Increased public confidence

6. • 1977 First Model list published, ± 200 active
substances
• List is revised every two years by WHO Expert
Committee
• Latest list in March 2011 (17th edition)
containing 350 drugs
• 3rd WHO Model List of Essential Medicines for
Children

7. • The core list presents a list of minimum medicine
needs for a basic health‐care system, listing the
most efficacious, safe and cost‐effective
medicines for priority conditions.
• The complementary list presents essential
medicines for priority diseases, for which
specialized diagnostic or monitoring facilities,
and/or specialist medical care, and/or specialist
training are needed.

8. Selection of essential medicines
• Two steps:
– Market approval based on efficacy , safety and
quality.
– Evaluation based on comparison leading to a list
for different levels of care.

9. • Factors such as
– Pattern of prevalent disease,
– Treatment facility,
– Training and experience of available personnel,
– Financial resources
– Genetic , demographic and environmental factors.

10. Selection Criteria
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Evidence of efficacy and safety
Relative cost effectiveness
Pharmacokinetics
Availability
Desired dosage form, bioavailability and
stability ensured
• Single compounds , in some cases fixed dose
combinations

12. The Essential Medicines Target
National list of
essential medicines
Registered medicines
All the drugs
in the world
Levels of use
S
CHW
dispensary
Health center
Hospital
Referral hospital
Private sector
S
Supplementary
specialist
medicines

13. Clinical guidelines and a list of essential
medicines lead to better prevention and
care
List of common diseases and complaints
Treatment choice
Treatment guidelines
Essential medicines list
/ National formulary
Training and
Supervision
Financing and
Supply of drugs
Prevention
and care

14. Practical applications
• Basic and in service training of health care
providers
• Public sector procurement and distribution
• Medicine benefits as part of health insurance
• Drug donations and international aid
• Monitoring systems on availability and pricing
• Public education

15. Key policy issues
• Access depending on : rational selection,
affordable prices , sustainable financing and
reliable health systems
• Selection linked to standard clinical guidelines
• Policies for procurement and supply and
health insurance
• Systematic and transparent procedure